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New Hampshire rates for HCPCS J0741

Injection Cabotegravir And Rilpivirine 2mg/3mg

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.63 / $26.47 / $47.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.64 / $23.65 / $23.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.19 / $42.57 / $107.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.65 / $23.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.31 / $23.65 / $23.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.81 / $38.40 / $73.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.65 / $23.65 / $23.65
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.70 / $22.77 / $28.98